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L5-2 Diagnostic methods & clinical characteristics - Coggle Diagram
L5-2 Diagnostic methods & clinical characteristics
dye
dye is applied with a cotton pellet on a clean and dry dental surface for 10-60 seconds. Rinse and dry.
the dye affects denatured collagen fibres.
enables the detection of caries that may go unnoticed by the dentist during the removal of the lesion.
inspection
Pits and fissures
an opaque area can be seen around the fissure and enamel can be matte an slightly porous
occasionally pigmentation at the bottom of a pit or fissure (diff dx)
difficult to detect a white spot as it starts at either side of the fissure and can’t be observed by direct vision.
the sensitivity of this method is low, leading to numerous false negatives.
Upon suspicion of caries in pits and fissures, the use of a probe must be done carefully to avoid damaging enamel that could be remineralized. Cariogenic bacteria can be transported from one tooth to another.
Proximal surfaces
inspection is not useful for the detection of caries in posterior teeth unless the adjacent tooth is missing or displaced, or the lesion is very advanced.
when a probe is retained on a smooth surface during exploration:caries. However:
Initial demineralization does not alter the surface and the probe feels no retention
A probe can break enamel that could have been remineralized
separation with wedges or orthodontic bands. / dental floss frays.
Free smooth surfaces: buccal and lingual
white spots are easily detected:
white, opaque, oval in a mesio-distal
between the widest diameter and the gingival margin (plaque retention)
as the lesion progresses, it becomes yellow, brown or black.
root surfaces
inspection may be impeded by gingival inflammation.
usually dark brown lesions with a soft surface.
these surfaces can be explored freely as there is no risk of extending the lesion by breaking the enamel surface.
near the gingival margin, associated to gingival retraction.
transillumination
proximal surfaces
use light
Kavo DIAGNOcam 透照
based on DIFOTI: transillumination by digital optical fiber
ligh-induced fluorescence
(Kavo DIAGNOdent)
detect fluorescence
has high sensitivity
can be used in hypocalcified enamel
the more fluorescence detected, the more decay within the tooth
radiographs
Advantages:
approximate depth of the lesion and proximity to the pulp
presence/absence of periapical pathology
detection of proximal caries before cavitation
detection of recurrent caries
gingival adaptation of restorations
Disadvantages:
it requires at least 40% demineralization, which means initial lesions are not detected.
it doesn’t show the real size of the lesion (lesions are always larger than what they seem on radiographs).
Free smooth surfaces
elliptical shape elongated to mesial and
distal
a radiograph will not give information on which surface is affected (buccal or lingual)
hard to diagnose with radiographs
it is best to use visual inspection for lesions located on these surfaces
Pits and fissures:
radiographs are not useful foRr iRnitial lesions on these surfaces. they only show up on X rays once the dentin is involved.
Proximal surfaces:
initial lesions are seen as an indentation on the external surface of enamel
Bitewings and periapical radiographs show caries at the contact point or immediately beneath it.
frequently, a lesion that appears to be limited to enamel will histologically also show dentin involvement.
moderate lesions have a triangular appearance with a base towards the external surface of enamel.
Advanced lesions show a radiolucent image which extends laterally once it reaches the DEJ, in dentin it will be triangular with a base towards the DEJ and a vertex towards the pulp chamber
Root surfaces:
Root lesions located on proximal surfaces are observed on radiographs as round radiolucid areas.
Differential Diagnosis
Enamel hypoplasia
systemic infections, malnutrition, acute local trauma, electrical burns, local infection, etc
usually just one tooth is affected due to periapical infection of the temporary tooth.
alterations due to lesions suffered during
dental development.
brown area with absent enamel.
Destructive processes
Absfraction.
Abrasion.
Erosion.
Fluorosis
white-chalk or grey.
symmetrical affectation.
the most affected areas are the incisal edges and cusps.
Enamel hypocalcification
hypocalcification spots can be located to a single tooth or have a symmetrical distribution .
not affected by dryness or moisture (while caries white spots disappear totally or partially with hydration).
Amelogenesis imperfecta
most teeth in the dentition are affected.
general sensitivity to cold.
hypoplasia, hypomaturation or hypomineralization of enamel.
hereditary enamel alteration
ALL TOOTH HAVE AFFECTED
